Tuesday, January 19, 2016

What's Up, Doc?

Bapaks in white coats continue to put the fear of God up Indonesia’s expats.

“Doctor, Doctor, I’m at death’s door!”

“Don’t worry, we’ll pull you through.”

This is not an exchange that I overheard in a Jakarta waiting-room, although Indonesia’s doctors, fine specimen of men and women that they most assuredly are, certainly come in for a fair amount of flak from the expatriate community. The general perception of the country’s professional bone-sawers held by those who hail from wealthier nations seems to bounce like a heart-rate monitor readout between patronizing ridicule and sheer terror at the prospect of ever falling into their clutches.

If they ply their trade at a more down-market hospital or medical centre, then local doctors are usually viewed as buffoons who offer diagnoses along the lines of “doctor, doctor” joke punchlines before pumping you full of the wrong drugs and amputating the wrong leg for good measure. However, if they work at a more salubrious house of medicine, then they will obviously try and hook you up to as many expensive machines that go ‘ping’ as possible, as the dollar signs revolve in their eyes like one-armed bandits (although American expatriates may be used to this kind of treatment as a result of their noble nation’s general disdain for socialized medicine).

One can head to the official statistics in search of a more sober analysis of the country’s medical system, however this may not help to dispel the negative aura that hangs over Indonesian hospitals like the smell of a full specimen jar.

Of Indonesia’s 1,800 hospitals, apparently only five are internationally accredited, and all of these are privately owned, although supposedly the health ministry is currently preparing another seven state-owned hospitals to qualify for international accreditation.

Ultimately, this may not make much of a dent, however, in the 100,000 or so locals who head abroad every year (mainly to Singapore, Malaysia and China) in search of decent medical treatment. And they are the lucky ones, of course. The vast majority of Indonesians, not in possession of a great deal more, asset-wise, than a bedpan, can either incur crippling debts when they require medical attention or instead opt for a judicious application of Tiger Balm whilst offering a few prayers to Him upstairs.

There have, however, been more recent signs of change. Both President Jokowi and his comrade-in-arms, Jakarta Governor Ahok, in a break with five decades of elite politics, actually seem to acknowledge that not all Indonesians drive BMWs and have pushed through medical insurance schemes, amidst much huffing and puffing from the trustees of the nation’s better-equipped hospitals.

Clearly though, this may well be like trying to fix a fractured skull with a Handiplast. Doctors here often work in a number of hospitals or health centres, and even hospitals that occupy fancy high-rise buildings may not be able to provide adequate or sufficiently professional consultation, as their doctors work long into the night with large numbers of patients. It seems that often here, high-end technology is not complemented by a similarly high-end level of professionalism among the nation’s 50,000 doctors and 2.5 million nurses.

The problem, as with so many things, lies with education, which in this country is about as bad as it gets. This is not a knowledge-based culture; it is a highly corrupt, consumption-based culture. Intellectually speaking, a complete disaster then includes the sale of places in med school (the lower your grades, the more you have to pay to get in; up to hundreds of millions of rupiah). Plus, of course, more payments will ensure that even the most chuckle-headed of potential quacks are able to pass their regular exams, whilst connections and the old-boy network also help, which is why medical care can seem so ‘dynastic’ here.

And all of this comes on top of Indonesia’s politically-motivated system of educational indoctrination, which is based around rote learning, and which seems to actively discourage the kind of critical thinking that is so valuable for the decent practice of medicine. Apparently, even nurses and midwives often have to buy their way into jobs. This can be as much as US$5,000 for a job that pays about US$300 per month. No wonder the nurses and doctors work for the government in the mornings and engage in private practice in the late afternoons and evenings.

Having said all this, my own experiences in Indonesian hospitals haven’t been too bad. Most seriously, I once rode my motorcycle into a bajaj that was seemingly being driven by some prototype Google software at the time. In any case, after being tossed in the air like a rag doll and landing in a big bone heap on the ground, I found myself being transported to Pertamina Hospital in South Jakarta having sustained several fractures.

After having various titanium plates and screws inserted into me, I was packed off home to recuperate and was also regularly visited by a nurse (alas, a male one) for the following two weeks. Both my inpatient and outpatient care were pretty decent, although all of this came at a price that was thankfully covered by my health insurance policy. Coincidentally, ex-President Suharto entered the very same hospital about a year later and, unlike myself, did not emerge alive. Perhaps the former strong man had been neglecting his health insurance payments (although I was always under the impression that the inscrutable old fascist was a collector, as opposed to a payer of premiums).

There was, alas, one dark cloud which cast a shadow over my otherwise delightful weeklong stay in hospital, and this was the nurses – angels of mercy that they were – who insisted upon waking me up at the very Indonesian hour of 5am every morning to administer nothing more than a vitamin pill and the most appalling breakfasts that I’d had since that time I went camping. After four days of this, I have to confess that I did offload some technical medical jargon in their direction.

“But we only trying to help you, Mr!”

“Aha, that’s very good, now here’s what I want you not to do…”

The great Benjamin Franklin supposedly claimed that “Early to bed, early to rise, makes a man healthy, wealthy and wise.” Well, he’d clearly never sailed around the Dutch East Indies, in my view.

Meanwhile, Indonesia’s poor may now be crowding hospital receptions the length and breadth of the nation clutching Jokowi Smart Cards, however many will still be unable to afford the fancy prescriptions dished out by doctors with a tendency towards polypharmacy (i.e. prescribing five or more drugs, many of which are non-essential but expensive if you’re on two dollars a day).

The quick fix offered by traditional jamu and over-the-counter energy pills and drinks is thus likely to remain a medical staple for the republic’s proletariat, who suffer the consequences of the fine line between commercial exploitation and medical science being gleefully trampled over. A quick fix of caffeine, taurine, sugar and paracetamol it is then, which should temporarily mask the negative effects of poverty, poor diet, lack of sleep, pollution, disease and parasites. Soviet Russia, now there was an efficient health system. As soon as you were ill, they’d kill you. No messing about with cures there…